Hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis: a meta-analysis

摘要

Highlights Gastric cancer accounts for the fourth-highest incidence of tumors worldwide and the second-highest mortality rate. And gastric cancer is highly heterogeneous, and the disease progresses rapidly. Most patients with gastric cancer are diagnosed as advanced at the time of initial diagnosis. Peritoneal hyperthermia chemotherapy (HIPEC) is a new technique that combines intraperitoneal chemotherapy with hyperthermia and peritoneal lavage. HIPEC combined with cytoreductive surgery (CRS) has unique advantages in the treatment of abdominal cancer and malignant ascites. The prognosis of gastric cancer peritoneal carcinomatosis (GCPC) remains poor despite recent advances in systemic chemotherapy. Current evidence supporting the treatment of HIPEC for GCPC is limited. The authors performed a meta-analysis of the efficacy and safety of HIPEC in GCPC treatment. Abstract Objective: To evaluate the efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of gastric cancer with peritoneal carcinomatosis. Methods: The relevant clinical controlled studies were retrieved from the databases of PubMed, Cochrane Library, Embase. Risk ratio (RR), as well as the respective 95% confidence interval (CI), was used as a statistical indicator. 1-year survival, 2-year survival, and safety were analyzed. Results: Two randomized controlled trials (RCTs) and 10 high-quality non-randomized controlled trials (NRCTs) were included, enrolling 837 patients (438 in the HIPEC group and 415 in the control group). Compared with the control group, HIPEC group turned out to be of greater improvement in long-term efficacy: 1-year survival rate (1y-os) and 2-year survival rate (2y-os). Subgroup analysis of different treatment modes in NRCTs showed that, in terms of 1-year survival rate, (1) HIPEC combined with cytoreductive surgery (CRS) compared with CRS alone, RR = 0.68, 95% CI: (0.53, 0.85); (2) HIPEC combined with intravenous chemotherapy ± CRS versus chemotherapy alone, RR = 0.54, 95% CI: (0.39, 0.74); (3) HIPEC combined with palliative gastrectomy versus palliative gastrectomy, RR = 0.37, 95% CI: (0.22, 0.63). As for safety,there were no significant differences in adverse events between two groups. Conclusion: HIPEC can prolong the survival of gastric cancer patients with peritoneal carcinomatosis, and the incidences of adverse events were not increased.